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General NPI Number Information
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NPI Number | 1821495631
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Entity Type | Individual
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Provider Name | NICOLE BERNDT
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Gender | Female
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Dates
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Enumeration Date | 11/21/2014
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Last Update Date | 11/21/2014
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Provider Practice Location Address
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Address Line | 1821 S WEBSTER AVE
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City | GREEN BAY
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State | WI
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Zip | 54301-2253
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Country | US
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Telephone | 920-496-1360
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Fax |
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Provider Business Mailing Address
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Address Line | W3319 SAND RIDGE RD
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City | PESHTIGO
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State | WI
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Zip | 54157-9592
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 6133-33
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License Number State | WI
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